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t � <br /> Rev 2/23/2009 <br /> r Page 3 of 6 <br /> Are there Oa <br /> l <br /> ^ � � A ere currently any registered or unregistered Yes No Unk <br /> storage tanks (above or underground) located on the <br /> property <br /> 1 Ob Did you observe evidence or do you have any prior Yes No {Unk <br /> r knowledge that there has been previously, any registered or <br /> unregistered storage tanks (above or underground) located <br /> on the property' <br /> Ila Are there currently any vent pipes, fill pipes, or access Yes iNo, Unk <br /> ways indicating a fill pipe protruding from the ground on <br /> the property or adjacent to any structure located on the <br /> property <br /> 11 b Did you observe evidence or do you have any prior YesNo Unk <br /> knowledge that there has been previously, any vent pipes, <br /> fill pipes, or access ways indicating a fill pipe protruding <br /> r from the ground on the property or adjacent to any structure <br /> located on the property2 <br /> 12a Are there currently any flooring, drains, or walls Yes ;No Unk <br /> ` located within the facility that are stained by substances •f <br /> other that water or are emitting foul odors? <br /> 12b Did you observe evidence or do you have any prior YesNNo� Unk <br /> knowledge that there has been previously, any flooring, <br /> � . drains, or walls located with the facility that are stained by ' <br /> i substances other that water or are emitting foul odors? <br /> 13a If the property is served by a private well,or non- Yes No Unk <br /> public water system, is there evidence or do you have prior <br /> knowledge that contaminants have been identified in the <br /> well or system that exceed guidelines applicable to the <br /> water system? <br /> ku 13b If the pioperty is served by a private well, or non- Yes No Unk <br /> public water system, is there evidence or do you have prior <br /> knowledge that the well has been designated as <br /> contaminated by any government environmental/health <br /> agency9 <br /> 14 Does the owner or occupant of the property have any Yes No Unk <br /> knowledge of environmental liens or governmental <br /> notification relating to past or recurrent violations of <br /> i environmental laws with respect to the property or any <br /> facility located on the property,' <br /> 15a Has the owner or occupant of the property been Yes Not Unk <br /> informed of the past existence of hazardous substances or <br /> petroleum products with respect to the property or any <br /> facility located on the property? <br /> e <br /> _ initials <br /> S <br />